apremilast + infliximab

Apremilast + infliximab is a combination therapy consisting of two distinct agents used primarily in the management of moderate to severe plaque psoriasis and psoriatic arthritis, particularly in patients who have not responded adequately to monotherapy with biologics. Apremilast is an oral small-molecule inhibitor of phosphodiesterase 4 (PDE4), which increases intracellular cAMP levels, leading to downregulation of pro-inflammatory cytokines such as TNF-α, IL-17, and IL-23, and upregulation of anti-inflammatory cytokines like IL-10[6][10]. Infliximab is a chimeric IgG1κ monoclonal antibody that binds with high affinity to both soluble and transmembrane forms of tumor necrosis factor alpha (TNF-α), thereby blocking its interaction with TNF receptors and disrupting downstream inflammatory signaling[8]. The combination aims to leverage complementary mechanisms—apremilast’s modulation of multiple inflammatory pathways via PDE4 inhibition and infliximab’s targeted neutralization of TNF-α—to achieve improved disease control. Clinical studies suggest this combination can be effective for patients inadequately controlled on biologic therapy alone; common side effects are gastrointestinal (nausea, diarrhea) but are generally manageable[1][2][3].